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Home My WebLink About0019 FOURTH AVENUE - Health 19 FOURTH OSTERVILLE A = 139 090 1 TOWN OF BARNSTABL; �V LOCATION /.uA942MJT-- SEWAGE # i VILLAGE ASSESSOR'S MAP & LOT . i INSTALLER'S NAME&PHONE NO. , SEPTIC TANK CAPACITY LEACHING FACIL=: (type) (size) ,NO.OF BEDROOMS BUILDER OR OWNER !If An tinv PERMITDATE: �J 1�i COMPLIANCE DATE: �q Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility)- Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Z a 1� AL G� d'JA- �.� No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIppfication for ;Dfgpogal *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Akdoress or Lot No. Owners Name,Addyreess�d Tel.No. Assessor'smap/Parcel 13� d 49® S �{ku(/ I e � q L L.,-)�j_ Lf�1 7 Installer's Name,Address,and Tel.No. s- Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable),M,n tj e Sep Aicc. `=A fA< I Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thi Boar f Health. Signed Date 7 19 Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued TOWN OF BARNSTABLE i LOCATION A, 741,411jOLv�4 Pw JT r` t SEWAGE # VII LAGS ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �� SEPTIC TANK CAPACITY Ao,:� LEACHING FACILITY: (type) (size) NO.OF BEDROOMS 1 BUILDER OR OWNER 11/1?��Tt� ,�' 62('-A" PERMITDATE: COMPLIANCE DATE: V7—.q Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet j Edge of Wetland and Leaching Facility(If any wetlands exist i within 300 feet of leaching facility) Feet Furnished by 117 / C' 1 - 7 y Z V V � i J i I i - rNo. r " Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 0(ppfication for �Digaar 6p6tern Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or No. n Owner's Name,Address d Tel.No. 'vtc t V 1.t.1 j2/T Psv Tom`` kh P, L-+!'f t Assessor's ap/Pazcel �� C) +0 � S �V t(/'e L�A A/40% Sir 77 yap L/"-I Installer's Name,Address,and Tel.No. t Designer's Name,Address and Tel.No. i�otit S I± Y C/4-vPtr ftq� u � Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria .other Fixtures Design Flow gallons per day. Calculated daily flow gallons. - Plan Date Number of sheets Revision Date Title _t Y Size of Septic Tank Type of S.A.S. 4 A Description of Soil n� Nature of Repairs or Alterations(Answer when applicable) M ,.u e SP - ,c A NIA, .S� Y-U Date last inspected: Agreement: The undeisigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by.this Boaz f Health. - Signed Irl, Date A 719 5 Application Approved by _ Date Application Disapproved for the following reasons :a e ' Permit No. M Date Issued ------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE MASSACHUSETTS ' '. Certificate of Compliance THIS IS TO CERTIFY, at the On-site Sewa a Disposal S� T±onstructed,( )Repaired( )Upgraded( ) Abandone i1 )by i �� at � k-- J `� o >1 `� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. / dated ` Installer Designer J 0 r A The issuance of this pe t shall-n• e construed as a-guarantee that the s to �inl as%psi , e} Date Inspecto Wig" ———————————————— --------------- `-- No. ," / Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi5po0af tp9tem Construction Permit Permission is hereby granted to Construct( ")Repair( )Upgrade( )Abandon( ) System located at_ 9 �.t/C.v r-e , d .S-k,w /fir and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of thi Date: /7 A9� Approved by 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated��y � � concerning the property located at (�,Win,,,,, R 7 meets all of the following criteria- • The failed stem i c system s connected ected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the ma.,dmum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed teaching facility will not be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation +the MAX. High G.W. Adjustment. _ DIFFERENCE BETWEEN A and B SIGNED : DATE: el/71 [Sketch proposed plan of system on back]. q:heslth folder:cen 3p rc pId 139090 �� e(=A'�V �A�� punt Nv 000740 � �,; 0000000 �e �" a �Q etL t LOT B r u r WHITE,NANCY A TR Sta e s 101 19 LADY SLIPPER LN ' OSTERVILLE MA 02655 ewe acct oo-0000-000 ��„z I ' f Jan 1 WHITE,NANCY A TR Ge - � 0696 ,� e ' 10277273 a 000098100 ulgs. 000170700 Xtra F a uses: 0000000000 ocat�on 19 ILFOURTH AVENUE rRpad Q 0562 �r g 0110 R re Est, CO WARREN STREET erinde . 1783 Fr�ng 0130 �� S a h f r Maps r e 139090 ,� ti; wicf 13arnsa , � isms i 's 9 tr f/ t< r-;, � ?• 3 P,r slt `!'nl( _ S� C O� � c�` " 99 575 an 1000 / 'r d-box replacement&move s.t. p 139090 ;ner WHITE,NANCY A TR 19 FOURTH AVENUE € d I lQ ION A G Z PEANUT We. VILLAGE INS7 +LLER'S NAME & ADD9ESS Ai 3 U 11. 11� aA QWI�aH iG r(=\ L DATE PERMIT ISSUED r DATE C 0 M P L I A N C E ISSUED -Zt/ai �6 �i Pam- L q nr� 3 yo ... THE COMMONWEALTH OF MASSACHUSETT5 BOARD OF HEALTH ,Apure#inn for Bispoiial Works Tonstrnrtion ramit Application is hereby mad fo a Perm', p Construct ) or Repair ( ) 'a_n Individual Sewage Disposal System at: g Ct. s�I � .............. -. v ' u�-r 4 -lava----- Os.; - ......-----------------------��--� ----------------- ... Location-Address or Lot No. Owner dress c '•s Pa r lcee- i2aG 0. s e l Installer Address Type of Building Size Lot... ....Sq. feet U Dwelling—No. of Bedrooms.................. .. _--_-Expansion Attic ( ) Garbage Grinder ( ). aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) W Other fixtures ................... ------------- - - Design R: Septic Tank—Liqui c city/9�_gallons per Length person per Total-day" d -daily flo w- Diameter--.__ _----_�Depth.__�lons: W W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No--------t----- iameter-------/0_------ Depth below inlet_...___..6....... Total leaching area...47....sq. tt. Z Other Distribution box ( .__..✓� Dosing tank ( ) / '-' Percolation Test Results Performed by.-BAV-S.W-- -- ,'/ -1!�! ........................ Date......... aTest Pit No. I________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ------------------------------------------- -....... --------- ----------------------------- -_----------- •---------------------------------------------- 0 Description of Soil----------------------------------------------•--------•...........-------------------------------------------------•-----.............................................. x ................................................. � J.._...m t..... .f ��2- --------------------------------------------------------------------------------- W ---------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------- VNature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------............................ _ ...............................................................=........................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal stem in accordance with the provisions of'T'LE 5 of the State Sanitary Code—The undersigned further agr es o t plac t e system in ope tion until a ert'•ca e of Com liance has issued by the oard of health. ' ignc ............ - I---------- .. ....... . Date 'Application Approved By------. .....C�. .•--•-----•------------------------------------------• ----= }Q Date Application Disapproved for the f o owing reasons---------------------------------------------------------------------------------------------------------------- ---------- ---------------------------- --- Date Permit No.......�K S---'---------1 Z g......................................... Issued............. ---------- -- -- - Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) Im A DATA ;W No.... F E 1 0..f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................................. ........ -.0. ..............OF....... Appliratiou for Dispasal Works Tont ttr inn rani -Application is hereby made for a Perm o Construct or Repair an Individual Sewage Disposal System at; V C-1 .67- Le;7-'r- .............................................. .....I..........................................................S)................. Location-Address or Lot No. ........................................................................................... ................................................................................................. Owner Address ........................................................... .................................................................................................. Installer Address U Size Lot_Type of Building Z�. A ...Sq. feet Dwelling—No. of Bedrooms__________________; .....................Expansion Attic Garbage Grinder ( ) P14 Other—Type of Building ............................ No. of persons__..__...___......__._....._ Showers Cafeteria ( ) Pa Other fixtures ..................................................I.......................................I--------- f. ---------- ---------------......Design Flow_______________ . ..2�.....................gallons per person per day. Total daily flow_______._._.__.__.._.._____.....3. W - .............................. ....__gallons. .1:4 Septic Tank—Liquid capacity&6'�Lgallons Length________________ Width................ Diameter__._-.________-_ Depth__.___________._ W Disposal Trench—No. .................... Width_.__._._._....._._._ Total Length..__._______________ Total leaching area....................sq. f t. �4 Seepage Pit No......../-----------I Diameter.......IQ...... *Depth below inlet___.___.:.....__ Total leaching area...—-.L_.sq. ft. Z Other Distribution box ( V� Dosing, tank ( ) , :;i.q Percolation Test Results Performed ------- C-i ) , Date......................................... ............................... Test Pit No. I----------------minutesperinch Depth of Test Pit___._____.._____.___ Depth to ground water_._._...._.._______._... (Z4 Test Pit No. 2................minutes per inch Depth of Test Pit_____._.___________. Depth to ground water-.-____....._______._... .............................................................................................................................................................. . 0 Description of Soil.................................................................................................................................................I_.................... wy .................................................................................................... . ........................................... U ............................................. W - ----------------------------------------------------------------------------------------------------------------- .......................... ........................................................... U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------!................................... ........................................................................................................................................................................................................ Agreement: The_"undersigned agrees to install the aforedescribed Individual Sewage Disposal stem in accordance with -- the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agr es, o to lac system in ope Dion until-'a Certificate of Compliance has bed issued by the rd of health. Da L--t &T Signed.. - ------------------------ P. 7' 7 ;�r D_ e-d By..... J�... ....................Application Approve C—------------------------------------.- ........ Date Application Disapproved for the fo, owing reasons:............................................................................................................. ................................7.................................................................................................................................................................... • 7 'Date Issued---------------I'_2.A...... .......,,. ..:Permit ........ ............................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................................................................................... Quatifiratr of Toutpliattrr TH S TO CERTIFY " id al Se ge.Disposal System constructed or Repaired V Th a 6\tthe lu byll_i� . .. . .... ------------------------------------------------------------------------------- Installer at.......A.....k1-4.Ckf......51. ......L ......4----- ..1.11f........................................................ has beer. instilled in accordance with the provisions of rINITLZ j of The State Sanitary Code s des rih in the application for Disposal Works Construction Permit No.......;.?.5......4-1-1)............. dated....... ....... .... . ...... .............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA ANT'iE THAT THE ie SYSTEW,WILL FUN 7 SA ISFACTORY.DATE ............. ................ ......... ........ .. ......................... Inspector....Ltn................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..OF.......................... No...:_ .... FEE........................ 1.7. ........................................ Butopos . Permission is hereby granted........ ........ .... .. =......... 7, ................................... •........................... to Construct or Repair Individual Sewage Disposal System atNo........................................................................................................................................................................ Street t�7 an as shown on the application for Disposal Works Construction Permit No......,............... Dated...................... .................. ......................................................................................................... IYA Board of Health ...... ... .... FORM 1255 HOBBS 4&1 WARREN. 1t. PUBLISHERS DA 7`.4 S/NGL.E �'.4M/GY -3 B.EO.eoo� NO G/a�.BAG� G.2/NOEi2 4SVk 2 7 �S.Sf17 XG TA.c%c: =330 X1,3 G.RD USA /ODO GAG. �"� � .D/SPoSA� P/T-USE /000 GAL of MAss A. X 2.� - �`7/ G.00. E:t�;HARI? 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